摘要
目的探讨接受自体骨髓干细胞回输治疗的肝硬化患者外周血淋巴细胞亚群表达率和免疫球蛋白浓度变化的临床意义。方法选取2010年9月至2013年9月入住南京军区南京总院消化内科并接受自体干细胞回输治疗32例肝硬化患者,分别在采集骨髓前、采集术后第3天、术后第7天检测患者外周血的T淋巴细胞(CD3+、CD3+CD4+、CD3+CD8+)、B淋巴细胞(CD19+、CD19+CD25+)的表达率以及免疫球蛋白(Ig G、Ig A、Ig M)的血清浓度。数据采用方差分析进行统计学分析。结果入组的肝硬化患者术后第3天的CD3+、CD3+CD4+、CD3+CD8+、CD19+、CD19+CD25+细胞表达率及均明显低于骨髓采集前,术后第7天的上述指标均比术后第3天明显升高,差异具有统计学意义(FCD3=12.264、FCD4=12.834、FCD8=23.357、FCD19=5.819、FCD25=4.246;PCD3=PCD4=PCD8=0.000,PCD19=0.005,PCD25=0.019),同时,术后第7天Ig A水平明显高于骨髓采集前及术后第3天(F=7.612,P=0.001)。年龄≤55岁肝硬化患者Ig G、Ig A、Ig M水平和CD19+、CD19+、CD25+表达率在术后第3天指标均明显低于骨髓采集前,而术后第7天上述指标均高于术后第3天和骨髓采集前(FIg G=10.059、FIg A=32.271、FIg M=3.711、FCD19=104.408、FCD25=17.393;PIg G=PIg A=PCD19=PCD25=0.000,PIg M=0.030),在3个时间点CD3+CD4+、CD3+CD8+表达率均无统计学意义(FCD4=2.772、FCD8=2.934,PCD4=0.071,PCD8=0.061)。年龄大于55岁肝硬化患者术后3天和7天的CD3+CD4+、CD3+CD8+、CD19+、CD19+CD25+表达率和Ig G、Ig M水平均较骨髓采集前明显下降,术后第7天上述指标较术后第3天明显升高(FCD4=43.823、FCD8=83.762、FCD19=27.801、FCD25=36.457、FIg G=10.224、FIg M=13.528;均P<0.001)。Child B级肝硬化患者CD3+、CD3+CD4+、CD3+CD8+、CD19+、CD19+CD25+表达率和Ig G、Ig M、Ig A水平在术后第3天均低于骨髓采集前,而术后第7天上述指标均明显高于术后第3天(FCD3=9.719、FCD4=15.591、FCD8=29.480、FIg G=4.251、FIg A=7.575、FIg M=27.888、FCD19=18.286、FCD25=5.305;PCD3=PCD4=PCD8=PIg M=PCD19=0.000、PIg G=0.019、PIg A=0.001、PCD25=0.008)。Child C级组肝硬化患者的情况与Child B级组患者相似(FCD3=20.338、FCD4=26.218、FCD8=39.178、FIg G=18.790、FIg A=17.336、FIg M=8.650、FCD19=65.244、FCD25=13.667;均P<0.001)。结论接受自体骨髓干细胞回输治疗的肝硬化患者,淋巴细胞亚群表达及免疫球蛋白浓度在骨髓采集后均会出现短期的下降,为了减少该治疗的并发症,更有效地提高治疗的效果,预防感染是必要的。
Objective To evaluate the effects of autologous bone marrow stem cells （ABMSC） infusion on peripheral blood lymphocytes and immunoglobulin in liver cirrhosis patients. Method A total of 32 cirrhosis patients were recruited to undergo ABMSC infusion. The peripheral blood was collected for assay of T lymphocyte subsets （CD3＋, CD3＋CD4＋, and CD3＋CD8＋） , B lymphocyte subsets （CD19＋ and CD19＋CD25＋） and serum concentration of immunoglobulin （IgG, IgA, and IgM） before infusion and at days 3 and 7 post infusion. ANOVA analysis was used in the study. Result The percentages of CD3＋, CD3＋ CD4＋, CD3＋CD8＋, CD19＋, and CD19＋ CD25＋ cells were higher at day 3 post infusion compared to day 0 and day 7 （FcD3= 12.264, FCD4= 12.834, FCD8= 23.357, FCD19= 5.819, FCD25 = 4.246; PCD3= PCD4= PCD8= 0.000, Pco19= 0.005, eco25= 0.019）. Meanwhile, the serum level oflgA was also higher at day 7 （F = 7.612, P =0.001 ）. In patients younger than 55 years, the serum levels of IgG, IgA and IgM and the percentages of CD19＋ and CD19＋ CD25＋ cells were lowest at day 3 and heist at day 7. （F1 gG= 10.059, F, gA= 32.271, F1gM= 3.711, FcD19= 104.408, Fcm5= 17.393; PIgG= PIgA= PCD19= PCD25= 0.000, PIgM= 0.030） . And there was no difference for the percentages of CD3＋CD4＋ and CD3＋CD8＋ cells at the three time points（FcD4 = 2.772, FCD8 = 2.934, Pep4= 0.071, PCD8= 0.061 ）. In patients older than 55 years, the percentages of CD3＋ CD4＋, CD3＋CD8~, CD19＋, and CD19＋CD25＋ cells and the serum levels of IgM and IgG were lowest at days 3 and higherest at at day 0 （FcD4= 43.823, FCD8= 83.762, FCD19= 27.801, FCD25= 36.457, Figc= 10.224, F1gM= 13.528; PcD4= PCD8= PCD19= 0.000 = PCD25= PlgM= PlgG= 0.000）. In patients with Child-Pugh B liver cirrhosis, the percentages of CD3＋, CD3＋CD4＋ , CD3＋CD8＋, CD19＋, and CD19＋CD25＋ cells and the serum levels of IgG, IgM and IgA were lowest at day 3 （FcD3= 9.719, FCD4= 15.591, FCD8= 29.480, F^gG= 4.251, F^gA= 7.575, F^gM= 27.888, FCD19= 18.286, FcD25= 5.305; PcD3= PcD4= PcD8= P1gM= PCDL9TM 0.000, PIgG= 0.019, P1gA= 0.001, PcD25= 0.008）. Patients with Child-Pugh C liver cirrhosis have similar tendency for the above parameters （Fcv3= 20.338, Fcv4= 26.218, FcDs= 39.178, F1gG = 18.790, FlgA= 17.336, F1gM = 8.650, FCD19= 65.244, FcD25= 13.667; PcD3= PCD4= PCD8= P1gG= P1gA= P1gM= PCD19 = PCD25= 0.000） . Conclusion After ABMSC infusion in cirrhosis patients, the lymphocytes of different subsets and immunoglobulin concentrations all decreased at short term. Thus it may be necessary to orevent infection after ABMSC treatment.
出处
《中华细胞与干细胞杂志（电子版）》
2015年第1期11-16,共6页
Chinese Journal of Cell and Stem Cell（Electronic Edition）
关键词
肝硬化
间质干细胞
移植
自体
淋巴细胞
免疫球蛋白
Liver cirrhosis： mesenchymal stem cell
transplantation, autologous：lymphocyte： immunoglobulin
